Starting Up The Health Information Exchange

Language - it is essential for one person to understand another. It allows us to grasp concepts through a system of signs, sounds, and characters. There are many different languages in the world, one of which is our native language, Filipino. In our own country, along with Filipino, there are other languages being used such as Ilocano, Kapampangan, Bisaya, and Maguindanaon. There was difficulty in Filipino’s acceptance as the “national language” because it is based on one language used in Southern Luzon: Tagalog. It was chosen because it is the common used language in the political capital, which is located in this area. The government had to initiate the use of Filipino nationwide, using it as a medium of instruction in schools.

For this week, the topic is on how the government can establish the Philippine Health Information Exchange (PHIE). The reason why I described language is to explain the concept through this analogy. In the present Philippine health setting, there are healthcare institutions such as hospitals and clinics that already record, store, organise, and access electronic health data. However this data, like language, is limited in use to only the institution that created it. With the goal of eHealth being universal healthcare, it is important for this healthcare information to travel to other institutions. For example, for a patient who changed doctors, all data gathered by the previous doctor (history of the patient’s illness, medications they are on, what procedures were done) can be given to the other to give him/her an idea of the patient’s current situation. Health reports can be collected and sent electronically from local health centers to the higher provincial, regional, and national health units so that health officers can decide on the focus of health programs in a timely manner. To do this, the different institutions have to use a common “language” for all this data. This is the purpose of Health Information Exchange (HIE).

Establishing such a system is not easy as it requires the cooperation of many health institutions and individuals. Just in the government sector alone, it appears daunting. The country has 16 regions and about 80 provinces. That’s a lot of health centers, health offices, and hospitals! So in order for it to work, careful preparation must be done. The DOH has already begun this process. So let’s look into what has been done, and what lies ahead.

Just like a language creates rules on spelling, pronunciation, and grammar, a set of standards for health data have to be developed. Included here is the structure and type of data, terms used, and the format. Administrative order 2013 - 0025 (eHSI Release 001) was created in 2013 to address HIE. In it, the the National Health Data Committee (NHDC) was formed. Part of it is the technical working group, who is in charge of defining and recommending health data standards. Also included in the order was a list of the standard code sets to be used, such as the Current Procedural Terminology (CPT) for clinical procedures and International Classification of Disease (ICD) for diseases.

Another important job of the technical working group is creating implementation policies, procedures, guidelines, protocols, and advisories. This is reviewed by the management steering group, another part of the NHDC, and later approved by the DOH. These issuances are important in the process of implementing standards by the DOH down the line. 

There are a couple of other things that need to be prepared. An organization must be formed to oversee implementation of the standards created and monitor the progress. This is part of the responsibilities of the NHDC management steering group. Current resources have to be identified and inventoried to determine the need for each. The Medium-term Information & Communication Technology Harmonization Initiative (MITHI) has begun conducting such inventorying of ICT resources across different organizations and institutions.

Other than material resources, human resources are needed for implementation. New ICT personnel are needed for health institutions that have no such experts. This falls under the education sector of the government (DepED and CHED), with their courses and subjects designed for computer use training. While such courses already exist, availability is still limited across the country due to the lack of equipment and teachers. The standard code sets have to be published and distributed so that existing ICT personnel of health institutions will know about them. Seminars, workshops, and other platforms of discussion are assigned to the technical working group as well to further increase awareness. 

Different health institutions, private and public, have to communicate and coordinate with each other to implement an HIE, so it is important to have a strong health network. Through private-public partnerships, the government can create and strengthen relationships with the private sector. The DOH also has to strengthen their relationship with the local government units (provinces and municipalities) across the country, as they have more control in the implementation of projects at the local level. These networks help make the process of harmonization of health data less difficult and easily accepted.

On the more technical side, there are two kinds of data architecture models for an HIE, decentralized or centralized. A centralized HIE has a central database that holds all health data, while a decentralized HIE does not. There can also be hybrid models. Based on the Philippine eHealth framework strategy created, the government has decided on a hybrid model, so a central databases have to be built. This includes registries of data like priority diseases, health institutions, and healthcare providers. The DOH is currently in the process of making these databases.

I mentioned MITHI earlier. What does that have to do with the HIE? MITHI is an initiative that supports not just eHealth, but all eGovernment-related ICT projects. eHealth solutions, such as services and applications, have to all be processed through MITHI so that they will follow the standards created and be integrated into the harmonization effort of all eHealth-related projects and programs. It is important that the NHDC make the convening agencies of MITHI, specifically Department of Science and Technology - Information and Communications Technology Office (DOST-ICTO), aware of the standards that they have developed (through discussion platforms mentioned earlier), so that they will take it into account when assessing existing and proposed eHealth-related projects.

The HIE is like a giant steel ball at rest. All these actions that the government have to do make up the force to get that ball rolling - to create the HIE. As you can see, this is just the beginning. The implementation, monitoring, and evaluation are also a big part for this system to succeed. But a strong beginning can help lead to a better outcome in the end. So let the ball roll and keep it rolling for as long as possible.

Sources:

1. About MITHI: Medium-Term Information and Communications Technology Harmonization Initiative. (2015). Accessed from MITHI website: http://mithi.gov.ph/mithi/.
2. Administrative Order 2013-0025 - National Implementation of Health Data Standards for eHealth Standardization and Interoperability (eHSI Release 001). (2013). Accessed from Department of Health Unified Health Management Information System website: http://uhmis.doh.gov.ph/draft-ao-national-implementation-of-health-data-standards-for-interoperability.html.
3. T.J. Herbosa. Plenary on eHealth Philippines: Deliverables, 2016 and Beyond. (2013). Accessed from Philippine Council for Health Research and Development website: http://www.pchrd.dost.gov.ph/index.php/downloads/category/75-plenary-morning-session?download=331:plenary-ehealth-philippines
4. R.E. Moya. Medium-Term Information and Communications Technology Harmonization Initiative (MITHI). (2013). Accessed from Department of Budget and Management website: http://www.dbm.gov.ph/wp-content/uploads/MITHI/July2013/The%20MITHI%20Journey%20by%20Usec.%20Moya.pdf.
5. Philippines eHealth Strategic Framework & Plan 2013-2017. (2013). Accessed from Department of Health Unified Health Management Information System website: http://uhmis1.doh.gov.ph/UnifiedHMIS/draft-issuances/229-philippines-ehealth-strategic-framework-and-plan-2013-2017-version-3-0.html